Young women in four Bay Area counties can now test themselves at home for sexually transmitted infections, and then get the results and any needed prescriptions without ever visiting a doctor's office or clinic.

The home tests are part of a pilot project designed to give women who have had unprotected sex, or are just curious about their health status, a convenient, cost-effective and potentially less embarrassing way to get screened for STDs, public health officials said.

The women will be able to test themselves for chlamydia, gonorrhea and trichomoniasis, which are among the most common STDs. Those infections often don't cause symptoms, but they can cause devastating long-term health problems and infertility if left untreated.

"You can send for your test and get your results back in the same amount of time it takes to make an appointment and go to a clinic," said Gay Calhoun, director of the STD Control and Prevention Unit in the Alameda County Public Health Department. "And you can do it any time during the day, without having to use stirrups."

The four counties - Alameda, Contra Costa, San Francisco and San Mateo - began the pilot program on April 17 to determine whether women will take advantage of the home-testing option, and whether such a program would be a cost-effective addition to the network of clinics and medical offices that screen for sexually transmitted diseases.

The kits are free and available to any woman age 18 to 30. They can be ordered at www.iknowsfbay.org.

Enrollment of 400

The counties, working with scientists from the nonprofit RTI International research group, plan to enroll 400 women in the pilot program before shutting it down to analyze the results. So far, 22 women have enrolled, RTI International officials said; they expect to end the program sometime in July. Each county will evaluate the results and decide whether to continue the program.

The kits come in plain white envelopes and include a cotton swab and collection container, plus instructions on obtaining a sample. Women send the sample to a lab at Johns Hopkins University that specializes in processing home tests, and a few days later they get a text or e-mail message telling them their results are available online.

If women test positive, they will be able to get an online prescription and pick up medication from a pharmacy of their choice. They may also be advised to seek additional tests for HIV or other sexually transmitted diseases. The entire process - from ordering the kit to getting the prescription - should take 10 to 14 days.

"I see it as a way of offering options, which is something I'm always interested in doing around sexual health," said Dr. Susan Philip, director of STD prevention for the San Francisco Public Health Department. "This is a way of letting young women take control of their sexual heath."

Similar studies

Similar programs are already in place in Los Angeles and Baltimore. A Johns Hopkins study of the Baltimore program found that 10 percent of the 400 kits that were received during the study period tested positive for chlamydia. Among those women who tested positive, 95 percent sought treatment after learning their results, according to the study.

The Johns Hopkins program that started in Baltimore has since expanded, and now men in some states - but not California - can order the tests, too.

The Bay Area project is the first to offer online prescriptions to women who test positive, meaning they may be able to avoid an office visit entirely, said Ishita Kapur, project coordinator with RTI International.

That's important because sometimes a visit to a doctor's office or clinic can be such a burden that women may skip testing, Kapur said. Young adults who either don't have health insurance or don't have a regular physician to turn to may be especially reluctant to get tested.

Fewer options

That's been a particular problem in Alameda County, where the closure of several Planned Parenthood clinics in recent years has left some women with few options to get STD tests, said Calhoun.

And then there's the embarrassment factor. Victoria Jones, who works with the Youth United Through Health Education program run by the San Francisco public health department and UCSF, said young women often tell her they don't want to go to a clinic for testing, for fear someone might see them.

"They don't want people talking about them," Jones said. "They don't want somebody thinking they might have something. We tell them you should just think about your safety, you shouldn't be thinking about what anyone else feels."